Pregnancy After Vasectomy:  Treatment Options for Men in NYC

by Alex Shteynshlyuger MD

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Children after Vasectomy: Is it Possible?

Children after VasectomyWhile vasectomy is considered to be a permanent method of birth control, about 5% of men eventually decide that they want to have children after having had a vasectomy.

While normally, it is nearly impossible to have children after a successful vasectomy through vaginal sex, it is possible to ‘undo’ or overcome the success of vasectomy procedure.

The good news is that most men can have children after prior vasectomy if they change their mind and want to have children. It is possible to have children after vasectomy but some work is required. Pregnancy after vasectomy requires additional treatment and added expense.

What are the Options for Having Children After Vasectomy?

A number of options are available to men who decide to have children after vasectomy.  The choice of approach to getting the female partner pregnant depends on numerous factors, including how long ago vasectomy was performed, the age and fertility potential of the female partner.  In general, three options are available

  1. Vasectomy Reversal
  2. Vasectomy reversal + IUI (intrauterine insemination)
  3. IVF (In-vitro fertilization) / ICSI (intra-cytoplasmic sperm injection) plus testicular sperm extraction or vasectomy reversal.

Vasectomy Reversal

The simplest way, at least theoretically, to achieve pregnancy after vasectomy is by performing vasectomy reversal.

Vasectomy reversal is exactly what it is.  During a vasectomy reversal, the surgeon reconnects the 2 parts of vas that were initially cut during the vasectomy.  Eventually, the sperm flows through the vas again and can be found in ejaculate and Voila! – you can get your partner pregnant through vaginal sex.

Vasectomy Reversal Has High Success in Getting Sperm to Flow but Does Not Always Lead to Pregnancy.

While vasectomy reversal is often very successful with success rates as high as 90% of having sperm in the ejaculate, that does not always lead to pregnancy.  The question is why?  It may be that the concentration and the quality of sperm are not as good.  More often than not, the issue may be related to the female partner who may also have decreased fertility potential.

While vasectomy reversal usually leads to the presence of sperm in the ejaculate  (semen) in close to 90% of men, only 40-60% of men after vasectomy reversal achieve pregnancy spontaneously through vaginal intercourse.

 It usually takes an average of 6 months after vasectomy reversal to regain adequate quality and sperm counts.

Vasectomy reversal is certainly considered to be the most cost-effective way to achieve pregnancy for many, but not all men.  This is especially true if more than 1 pregnancy is planned.

Vasectomy reversal is performed using microsurgical technique using an operative microscope.  The procedure usually takes a few hours and the patient goes home the same day. Recovery is similar after vasectomy.

IVF (In Vitro Fertilization)

In vitro fertilization is another option for having children after vasectomy.  Sperm can be obtained directly from the testicle by micro-aspiration, testicular biopsy, or microscopic testicular extraction (micro-TESE).  This sperm is then used for in vitro fertilization of the egg before the embryo is implanted in the uterus.

In vitro fertilization may be a preferred option for couples with a known sub-fertility issue in the female partner such as PCOS (polycystic ovarian syndrome), difficulty with pregnancy in the past, age close to or over 35 years old, when the fertility potential in women decreases significantly.  In situations where the need for IVF may be significant, even in the absence of vasectomy, vasectomy reversal may not be cost-effective.

In vitro fertilization may also be a preferred option for men who had subfertility and problems with fertility prior to the vasectomy, such as poor sperm motility and morphology, low sperm numbers, and poor sperm quality.

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